Method for developing an anatomic space for laparoscopic hernia repair

Abstract

Method for developing an anatomic space for laparoscopic hernia repair comprising separating a first layer of tissue from a second layer of tissue for creating an anatomic operating space for the performance of a surgical procedure by making an incision through the first layer of tissue. A non-elastomeric deflated balloon is introduced into the incision. The balloon is inflated to cause separation of the first layer of tissue from the second layer of tissue to thereby produce an anatomic operating space. The balloon is then deflated and removed from the incision. The anatomic operating space is inflated with insufflation gas. A surgical procedure in then performed in the anatomic operating space.

What is claimed is:  
     
       1. A method for a lauaroscopic hernia repair through the preperitoneal space in a body having an abdominal area with an abdominal wall and a preperitoneal area underlying the abdominal wall, comprising making an incision in the abdominal wall into the preperitoneal area, introducing an inflatable balloon in a deflated condition into the incision and into the preperitoneal area, inflating the balloon to create a dissected preperitoneal space, deflating the balloon, removing the balloon from the dissected preperitoneal space, inflating the dissected preperitoneal space with a gas, introducing a graft into the dissected preperitoneal space and positioning the same so that it overlies the area of the hernia and deflating the dissected preperitoneal space while permitting the graft to remain in contact with the area of the hernia in general alignment with the hernia to provide reinforcement for the abdominal wall in the area of the hernia, the hernia being an internal hernia having a hernia sac extending through an inguinal ring of the inguinal floor, the graft introduced including a sheet-like disk having a central portion and a tail secured to the central portion, securing the tail to the hernia sac, dissecting the hernia sac in a region which is spaced from the portion of the hernia sac to which the tail is secured to provide distal and proximal portions of the hernia sac which are separated from each other to permit the tail to be carried with the distal portion of the hernia sac through the inguinal ring, closing the proximal portion of the hernia sac, the deflating of the dissected preperitoneal space permitting the graft to contact the inguinal floor and to be disposed between the inguinal floor and the overlying tissue. 
     
     
       2. A method for a laparoscopic hernia repair through the preperitoneal space in a body having an abdominal area with an abdominal wall and a preperitoneal area underlying the abdominal wall, comprising making an incision in the abdominal wall into the preperitoneal area, introducing an inflatable balloon in a deflated condition into the incision and into the preperitoneal area, inflating the balloon to create a dissected preperitoneal space, deflating the balloon, removing the balloon from the dissected preperitoneal space, inflating the dissected preperitoneal space With a gas, introducing a graft into the dissected preperitoneal space and positioning the same so that it overlies the area of the hernia and deflating the dissected preperitoneal space while permitting the graft to remain in contact with the area of the hernia in general alignment with the hernia to provide reinforcement for the abdominal wall in the area of the hernia, the step of introducing a graft including the steps of providing an additional balloon in two rolls rolled inwardly towards each other with the graft being disposed on one side of the additional balloon in the rolls, and introducing the roll into the dissected preperitoneal space and positioning the roll in the desired location, inflating the additional balloon to cause the additional balloon to cause the rolls to unroll in opposite directions to place the craft in the vicinity of the hernia. 
     
     
       3. A method of separating a first layer of tissue from a second layer of tissue for creating an anatomic operating space for the performance of a surgical procedure comprising: making an incision through the first layer of tissue; introducing a deflated balloon in a rolled-up configuration into the incision; inflating the balloon to cause the balloon to unroll and cause separation of the first layer of tissue from the second layer of tissue thereby producing an anatomic operating space; deflating the balloon; removing the balloon from the incision; inflating the anatomic operating space with an insufflation gas; and performing a surgical procedure in the anatomic operating space. 
     
     
       4. A method of separating a first layer of tissue from a second layer of tissue for creating an anatomic operating space for the performance of a surgical procedure comprising: making an incision through the first layer of tissue; introducing a substantially pear-shaped non-elastomeric deflated balloon into the incision; inflating the balloon with a saline solution to cause separation of the first layer of tissue from the second layer of tissue thereby producing an anatomic operating space; deflating the balloon; removing the balloon from the incision; inflating the anatomic operating space with an insufflation gas and performing a surgical procedure in the anatomic operating space. 
     
     
       5. A method of separating a first layer of tissue from a second layer of tissue for creating an anatomic operating space for the performance of a surgical procedure comprising: providing a deflated non-elastomeric generally pear-shaped balloon having side margins; rolling up the side margins of the balloon into two rolls to provide a balloon having a rolled-up configuration; making an incision through the first layer of tissue; introducing the deflated balloon in a rolled-up configuration into the incision; inflating the rolled-up balloon to cause the balloon to unroll in opposite directions to cause separation of the first layer of tissue from the second layer of tissue thereby producing an anatomic operating space; deflating the balloon; removing tile balloon from the incision; inflating the anatomic operating space with an insufflation gas; and performing a surgical procedure in the anatomic operating space. 
     
     
       6. A method of separating a first layer of tissue from a second layer of tissue for creating an anatomic operating space for the performance of a surgical procedure comprising: providing a tunneling shaft; mounting a deflated balloon on the tunneling shaft; making an incision through the first layer of tissue; 
       introducing the tunneling shaft with the deflated balloon therein into the incision; inflating the balloon to cause separation of the first layer of tissue from the second layer of tissue thereby producing an anatomic operating space; deflating the balloon; removing the balloon from the incision; inflating the anatomic operating space with an insufflation gas; and performing a surgical procedure in the anatomic operating apace.  
     
     
       7. A Method as in claim  6  together with the step or removing the tunneling shaft after the balloon has been removed from the incision. 
     
     
       8. A method for a laparoscopic hernia repair of a hernia area having a hernia sack in the vicinity of the internal inguinal ring in the pubic area in a body having an abdominal area with an abdominal wall and a peritoneum underlying the abdominal wall with a natural tissue separation plane therebetween by use of a rigid tunneling member having a distal extremity and a deflated inflatable balloon carried by the rigid tunneling member and a hernia patch, comprising making an incision in the abdominal wall in the vicinity of the umbilicus into the natural separation plane anterior of the peritoneum, introducing the rigid tunneling member with the deflated inflatable balloon thereon into the incision and into the natural tissue separation plane and advancing the same into the pubic area to cause further tissue separation along the natural tissues separation plane, inflating the balloon to create additional tissue separation to create a dissected anatomic space overlying the peritoneum and exposing the hernia sack in the hernia area and the internal inguinal ring, deflating the balloon, removing the balloon from the dissected anatomic space, inflating the dissected anatomic space with a gas, dissecting the hernia sack from the surrounding tissue in the hernia area, introducing a hernia patch into the dissected anatomic space and positioning the same so that it overlies and is in contact with the hernia area where the hernia sack was dissected and deflating the dissected anatomic space with the hernia patch in place so that the abdominal wall applies a retention force to the hernia patch. 
     
     
       9. A method as in claim  8  wherein the balloon is formed of a non-elastomeric material and has a shape in plan corresponding to the desired dissected anatomic space together with the step of inflating the balloon to create a dissected anatomic space which ensures that the hernia sack and the internal inguinal ring will be exposed. 
     
     
       10. A method of separating a first layer of tissue from a second layer of tissue for creating an anatomic operating space for the performance of a surgical procedure comprising: making an incision through the first layer of tissue; introducing a deflated balloon into the incision; inflating the balloon to cause separation of the first layer of tissue from the second layer of tissue thereby producing an anatomic operating space; deflating the balloon; removing the balloon from the incision; inflating the anatomic operating space with an insufflation gas; and performing a surgical procedure in the anatomic operating space.